Save Our Hospitals is a resident-led campaign group formed in July 2012. We are FIGHTING against the NHS plans to DEMOLISH Charing Cross Hospital and downgrading of our A&Es( Hammersmith, Charing Cross, Ealing and Central Middlesex Hospitals)

Friday, 6 February 2015

Labour's new plans to reduce private profiteering in the NHS have triggered a vicious counter-attack in the Tory press. Labour must ignore them - and do more to convince campaigners of its intent to protect and restore the NHS.

One after another the spokespeople for corporate interests vied for headline space in the Daily Mail, the Telegraph, Times and broadcast media. Alan Milburn, Labour minister turned shameless millionaire adviser to health privatisation firms was quick on the draw, followed by Lord Hutton - Labour minister turned director of failing private health company Circle. Lord Darzi, Labour minister turned Boris Johnson sidekick, popped up on Newsnight to have his two-pennyworth, backed up by Blairite academic and pro-market fundamentalist Julian Le Grand.

Labour’s new 10-Year Plan for Health and Care was released a week ago. It goes further than previous statements in shedding the enthusiastic promotion of market competition that so discredited the last Labour government.

Labour’s right-wing critics are especially furious that Labour should return to the designation of the NHS as “preferred provider”. The Plan questions the fundamental right-wing premise that the private sector has a central role to play in delivering health care.

In the Telegraph, columnist Charles Moore responded with paroxysms of rage, lashing out with an extended diatribe denouncing the NHS itself from its very origins, even while rather awkwardly trying to argue that Churchill (who opposed the NHS Bill all the way through parliament) was somehow the real founder of the NHS.

Whatever problems campaigners and health workers might see in the new Labour policy, the fact that it incurs such venomous responses from the usual suspects on the right must mean there is something going for it.

Labour has finally cottoned on to the NHS as a prime election issue, and at least partially remembered it is supposed to be an opposition.

“Putting the wrong values at the heart of the NHS, with a rampant postcode lottery, increasing rationing of treatments, and an ideological market framework which puts competition before collaboration and profits before patients, and which is seeing large amounts of money wasted on competition bureaucracy and competition lawyers.”

It’s all true – except that all of these problems began under Labour, as a result of the decision by Blair, Alan Milburn as Health Secretary and his successors to create a competitive market in health care. This was Labour policy from 2000 to autumn 2009, when Andy Burnham took over and made the NHS the “preferred provider”.

However Labour’s plan now is not to dismantle the market in healthcare that has been created in the last 25 years, encouraging private providers to take over vital services, but to tinker with it.

The 10 Year Plan promises to scrap the competition rules, and once again establish the NHS as the “preferred provider” of health care: but there are no bold plans to follow Scotland and Wales and abolish the split between “commissioners” and providers of health care, which the Tory Health & Social Care Act has widened.

If the NHS is to be a “preferred” provider it’s clear other providers will still be in the frame: indeed Andy Burnham and other Labour leaders still explicitly argue for a continued ‘supporting role’ for the private sector.

The 10-Year Plan commits to early action to “repeal the Health & Social Care Act”, including the hated Section 75 and its regulations, and “replace the current NHS market …” But in contradiction it also insists Labour will not impose a ‘major top-down reorganisation’, so leaving the market split in place.

Labour also promises to re-impose strict limits on private patient income for Foundation Trusts, extend Freedom of Information legislation to cover all providers of NHS services, and protect the NHS from the EU-US TTIP treaty that could force open services to competition.

All this looks fine on paper – but if this is what they plan to do, why would Labour refuse to amend the wording of the private members’ Bill from Clive Efford to repeal the HSC Act, which defined the NHS in terms that would leave it wide open to EU competition law and TTIP?

There is also a promise to increase NHS spending by an extra £2.5 billion, and invest most of this in an extra 20,000 more nurses, 8,000 more GPs, 3,000 more midwives and on top of that recruit 5,000 new homecare workers, to be employed by the NHS.

These are all good proposals, but far from quick or simple to achieve. It takes seven years to train a GP: so how many more will be in post before the 2020 election? An estimated 6,000 nurses had to be recruited from overseas in 2013-14 – mainly from the EU because of racist immigration laws – to keep NHS hospitals running. Labour promises to train more, but says nothing about the freeze that has slashed NHS pay by 16% in real terms since 2010, making it harder to recruit.

New money is also needed for the NHS: but the £2.5 billion promised by Labour is not enough. It falls far short of the £8bn NHS England boss Simon Stevens says is needed, alongside to partially counteract the staggering £22billion “efficiency savings” his Five Year Forward View suggests will be necessary to bridge a projected £30bn spending gap by 2021.

There is also a predicted £4bn gap in funding for social care, which has ever more restrictive “eligibility criteria” excluding all but the most vulnerable from any support. To improve social care means relaxing these strict rules, expanding services – and proper funding.

Labour proposes to remedy the “neglect of social care,” tackle “exploitation” by banning zero hours contracts, and drive out “the culture of care visits limited to 15 minutes”. It wants services run from a single budget, led by the NHS.

This is welcome news: but the exploitative regime in social care flowed from thewholesale privatisation of domiciliary care, much of it under Labour, driven by constant year-on-year cuts in the budgets of local councils who commission services.

To reverse the process, bring social care back into public ownership and control, improve pay and conditions and enhance the quality of services would be expensive. Many councils – probably including some Labour councils – will stand out against these changes, especially since Labour is reluctant to impose them from above. This would bring a new “postcode lottery” on social care.

Now Andy Burnham says he is proposing to hand NHS commissioning over to council-led Health and Wellbeing Boards, which would be advised by the existing Clinical Commissioning Groups. This is a massive gamble on the largely unknown capacity of HWBs to take on such responsibility. No councils have made use of the flexibility in the Health & Social Care Act to make these broad, inclusive, dynamic bodies questioning the levels of local health services.

Many HWBs are virtually invisible to the local public, effectively no more than closed meetings of council and NHS bureaucrats discussing public health and health promotion. They are at best obscure and unexciting, and at worst an obstacle to local change.

Would councils be funded for the extra work? Are councillors and unelected council officers really to be put in charge of much larger NHS budgets? Isn’t this a large-scale top-down change?

With all these gaps and contradictions in their new policy, Labour could well fail to convince sceptical health workers or many others who were aghast at their marketisation experiments last time in office.

However on paper these latest Labour policies, however flawed, do seem to at last to offer an alternative to the Tory-led coalition: the proof of sincerity will be in Miliband’s willingness to address the weaknesses highlighted by campaigners and deliver the promised changes without further concessions to a hostile Blairite and Tory opposition.

One thing’s clear: whatever your opinion of Labour, a majority Tory government back for five years in May would spell the end of the NHS.

It’s harder now to argue there’s no difference between the main parties: but if Labour wins, campaigners will still have to be ready to fight to make sure Labour stick to the promises made here, go further to scrap the market and its wasteful bureaucracy, and roll back the disastrous tide of privatisation.

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Many of our precious hospitals are being prepared for handover to private developers - and from PropCo to the Infrastructure Bill, the government is stripping away barriers to this firesale.

Are NHS hospitals the new target for rentier capitalism?

The NHS - particularly A&E - is in crisis. Worsening waiting times and overcrowding, patient safety being breached, and already the second lowest number of beds per person in Europe…

So why are those responsible for our NHS behaving like Estate Agents running an auction sale of its buildings and assets?

It is hard to find any reference to the NHS, whether in newspapers, strategic plans, or think tank proposals, that doesn’t include a recommendation to sell-off the land and assets.

Of course it is always clothed in the jargon of efficiency, modernisation and maximising utilisation as anything but a publicly owned hospital. It’s even dressed up as fairness and common sense.

For example:

Sell off NHS land for care homes, urges Lib Dem MP and former health minister Paul Burstow. His review also suggests planning rules could be relaxed and discounted prices offered to encourage investment.

Sell off Charing X Hospital for flats and a smaller clinic, suggests The Imperial Health Board.

‘Pump prime’to unlock assets held by NHS Property Services, instructs NHS Chief Executive Simon Stevens in his Five Year Plan.

There are at least £7.5bn worth of NHS sites currently deemed ‘surplus to requirements’, says the Department of Health.

“Ministers should actively seek to achieve value for the taxpayer and consider disposal in order to release resources for the frontline.” agrees Labour in their new 2015 policy document ’10-year plan for health & care’.

And finally - though it isn’t hard to find more examples - here’s some recommendations from the London Health Commission, chaired by Professor the Lord Darzi on behalf of the Mayor of London –

“Recommendation 53: (….) trusts have the incentive to dispose of surplus assets.

Recommendation 54: (…) trusts are encouraged to transfer assets for redevelopment and disposal.

Recommendation 55: (…) to transfer assets from the NHS to other parts of the public sector.

Recommendation 56: (…) ensure that estates planning and a comprehensive asset database are part of wider service planning.

Recommendation 58: (…) be permitted to include affordable housing as part of wider site redevelopment plans.”

The London Health Commission’s findings prompted SP, the firm behind the engineering design for the Shard, ‘to analyse the opportunities for redeveloping the (NHS) real estate,’ it was reported.

But elsewhere developers didn’t have to go looking for what might be available. The government was out spreading its wares for them in London at a property fair, MIPIM 2014 where one of the sessions was ‘Exploring healthcare: opportunities for the property industry’, explaining to international investors how to cut themselves a slice of the NHS estate.

And the government is busy making the NHS property sell-off even easier.

Let’s start with the most recent piece of the puzzle first.

The Infrastructure Bill currently making its way through the final stages in parliament has attracted controversy for the ‘Cameron loophole’ to allow fracking under homes without planning permission, as well as threatening ancient woodlands and a new era of private, toll highways.

But one small part of the Bill, the Public Sector Land Assets section, could allow the government to sell off any public land it chooses, whilst cancelling public access and use without consultation. Clauses 21 and 22 allow property to be transferred from any public body to the Homes and Communities Agency (HCA) and for it to then be sold to developers free from any previously existing public rights.

It’s another big step towards an unregulated fire-sale of public assets. Planning laws are being pushed aside and local powers to protect public assets are being stripped away in the race to transfer land from public ownership to private profit opportunity.

Hospitals, clinics and other NHS property are squarely in the sights of the purchasers.

In December 2014 the Independent described how the government has already ‘given up’ 2 million square metres of property since the Coalition came to power – the equivalent of 20% of its estate.

“The Cabinet Office is aiming for up to £6bn of extra receipts from property by 2020 – as part of its ambitions to find £10bn of savings by 2018 and up to £20bn by 2020 – not just from giving up offices, but airfields, barracks and prisons. Property developers would like the politicians to get on with it. Those builders that have been urged to solve Britain’s housing shortage say it would be easier for them to do so if the Government got on with releasing the estimated 40 per cent of land on which it is sitting in the shape of surplus Ministry of Defence and NHS sites.”

If we go back a bit, we can see that the politicians have been ‘getting on with it’ for quite a while. In February 2010, three months before the General Election, Labour’s Housing Minister John Healey launched the Homes & Communities Agency’s (HCA) Public Land Initiative. It offered a £53 million scheme to identify public sites - and to dispose of them at nil value. It set up an agreement to ensure the value was repaid ‘at some point in the future’.

In other words, the scheme transfers the ownership on a buy now, pay later (when and if you’ve made a profit) basis.

The previous government’s scheme was modest - aiming for the building of 1,250 homes on ex public land, 500 of which would be available for ‘affordable’ rent (though not council housing) and ‘low cost home ownership’.

The accelerating sell-off

But as soon as it was elected, the Coalition Government accelerated this release of ‘surplus’ public land. Its 2011 HCA Development and Land Disposal Strategy moved the release of public land and assets ‘for the creation of new homes and employment opportunities’ to the top of its agenda. Clause 8 also stated the HCA would be included in the Public Right to Reclaim Land. This misleadingly named law gives individuals and private organisations the right to identify public land they considered unused or underused by its current occupiers. A successful application means that the Secretary of State can insist that land or property should be sold on the open market, if the current owner can’t show it has an acceptable designated use for it.

In December 2011 NHS Property Services Ltd (PropCo) was formed - curiously, in advance of the Health & Social Care Act 2012, which (at clause 300.8) allowed the creation of such a company wholly or partly owned by the Secretary of State for Health.

PropCo was formed with a single £1 share, currently held by the Secretary of State for Health, and listed at Companies House.

The precipitous creation and particular legal form of this new organisation caused concern at the House of Commons Health Committee. The National Audit Office investigated and uncovered failures of good practice. It noted that the government had failed to properly consider forms of public ownership and failed to provide detailed operating objectives. The NAO noted that one of the outlined advantages of setting up a company was the possibility of a future complete sale to the private sector.

In April 2013 when Strategic Health Authorities and Primary Care Trusts were abolished every piece of NHS land or property deemed ‘surplus’ (including any administration buildings or clinics with more than 50% administrative use) were transferred to PropCo.

Since the HCA was already busily selling off our assets as fast as it could, why was there a need for a separate property company, just for the NHS?

What's the point of PropCo?

It appears PropCo was created to take full advantage of the provisions of the 2006 Act (section 223) which ‘frees’ the NHS Estates to use property at their disposal for purposes other than providing health services.

In simple language, the two Acts provide that:

· The Secretary of State can form a property company.

· Private companies may also hold shares in the company

· The Secretary of State is not required to retain whole ownership of the company

· The Act allows any transfer of NHS property and staff to the company and its shareholders

· The number of shares the Secretary of State has to hold is not stipulated within the legislation - allowing ‘partnerships’ with the private sector in future.

PropCo also assumed responsibility for running those primary care buildings that had already been incorporated into public private partnerships in the Local Improvement Finance Trust Programme (LIFT) created in 2000, in which the Department of Health has a minority (40%) stake. The LIFT Estates originally were designed for private investment in primary health and social care facilities. Now they also cover libraries, leisure centres, children’s centres and education services. PropCo is contracted to run the NHS LIFT scheme by another arm’s length company, Community Health Partnerships (CHP), which developed them.

The world of public private partnerships is a convoluted one. The Department of Health issued a FAQS sheet prior to launch of PropCo.

· Why do you need a new company? What was wrong with the old system?

· The new company has been set up as a result of the government’s reforms of the NHS

· What specifically can NHS Property Services do differently to PCTs?

· We are clear that bringing together a skilled workforce who maintain, manage and develop NHS Estate and properties will bring real benefits to the health service, particularly in terms of driving efficiency, releasing facilities that are no longer required [my emphasis] and focusing on modernising and improving NHS facilities for patients and staff.

By December 2012 when this fact sheet was written, already 3,600 assets had been identified for transfer to PropCo. ‘Independent expertise’ from companies Bevan Brittan and Mills and Reevewas employed to ensure proper legal transfer of assets was undertaken on all 3,600 estates, properties and facilities.

An extraordinary new clause called the Right to Contest was brought in on 8 January 2014 to be added to the Public Right to Reclaim Land. This extended the grounds for a request. It means that for land and property held by government departments and the majority of their arm’s length bodies a request can be made to release it even if it is currently in use on the grounds that there is a better economic use for it.

If PFI is Wonga, then PropCo is surely Cash Converters

Already it is clear where money is going. Properties previously owned by PCTs and SHAs have been moved out of local ownership and control, a system which ensures that overheads are kept as low as possible – into PropCo, a centralised limited company. That company not only owns them but has to charge rent and maintenance fees and sell off land and assets as it has to generate and maximise its own income.

The government is now selling our public capital assets off to the private sector with unseemly haste, even moving health services out at their request in order to make them ‘surplus’ to requirements. And it’s then allowing the private sector to pay if and when they make a profit on speculative housing development. Meanwhile if the NHS wishes to continue to use the facilities it once owned it must pay market rents for them.

This process extends far beyond the NHS into every area of public ownership. But its effect on the NHS has to be seen in conjunction with the other policy theme the think tanks are pushing - “close to home” care. What is absent from all these ‘patient centred’, ‘integrated’ pledges and compassionate commitments is hospitals and buildings in general. It’s all going to take place right in your own home where a team of experts will gather to help you spend your very own personal budget on your health plan of choice.

The government claims it wants to sell capital assets to pay off debt or pay running costs. But the sale is undermining any future potential for developing public ownership or public delivery. Since Margaret Thatcher came to power in 1979 we have been told the economy is like a household budget and we must live within our means. But an earlier Conservative PM, Harold Macmillan said of her policies ‘How do you treat a cold? One nanny said, ‘feed a cold’; she was a neo-Keynesian. The other said, ‘starve a cold’; she was a monetarist’. We are being starved and stripped of all we own. And it is likely to produce a sickness both inside the NHS and out that we will not easily heal.

If PFI is Wonga.com for the State then surely PropCo is Cash Converters. Once the assets are transferred out of the realm of health, out of public ownership, the cost of reclaiming them in the future is always just out of reach.

Our capital base, all that land and all those assets, represent a value for the future that cannot be easily represented. Just as PFI increases the financial drag away from clinical care into buildings and maintenance, so long term ownership of our assets decreases it. It gives the NHS the flexibility for reuse or new use. Having to repurchase on the private market takes away this flexibility, especially in times of rising property values.

Now NHS buildings are increasingly in the control of specially designed companies whose structure allows for the sale of shares to the private sector, effectively losing all we own in one fell swoop.

Going…going…gone.

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Few patients realise that if their local A&E misses its waiting time targets, or receives too big an increase in the number of its A&E patients, it is hit with huge fines. Just one hospital, Royal Stoke, this month revealed it has had to set aside £2million for fines for missing targets (including a £3/4 million fine for long A&E waits). Imposing such fines on already struggling hospitals is a singularly stupid policy, when A&Es are mostly just the frontline to which problems elsewhere in the NHS back up.

As for beds, in the last year we’ve seen the re-emergence of an old term - ‘bed blockers’ - or less offensively, ‘delayed discharge’. The idea that our hospitals would work just fine and there’d be plenty of beds if they weren’t clogged up by patients who don’t need to be there.

But as even its advocates at the Kings Fund admit, ‘care in the community’ isn’t a cheap option - without a hefty injection of funds, ‘care in the community’ will just mean poorer quality (or no) care - as we saw with mental health provision in the 80s.

We need to tackle the cuts in the creaking adult social care system with both better funding and addressing the massively privatised nature of that system. Labour’s announcements this week suggest they are prepared to set aside some extra cash for more social care workers. But - despite shadow health secretary Andy Burnham's welcome promise to "call time on the market experiment in the NHS" - there are still fears. This week Burnham was pressed - but refused - to put a figure on just how big a "supporting role" Labour would still condede to the private sector. And he has been silent on how far Labour would strip away the even more advanced and failing "market experiment" in social care. Without fully tackling the privatisation in both sectors, money will just continue to drain out of the public purse into investors hands.

Whatever happens in social care, though, people will continue to have emergencies. And emergencies are inherently unpredictable - and therefore not an attractive business model for the private sector. A&E is also disproportionately used by lower income groups, figures show - and who can make a profit out of them?

Caroline Molloy is Editor of OurNHS and a freelance writer. In 2011/12 she was part of a successful campaign which reversed one of the largest planned NHS privatisations in the country, involving 9 Gloucestershire hospitals. Since then she has been campaigning alongside local and national groups to defend the NHS.